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Home My WebLink AboutTR-12 (2) CREEK BOARD OF TOWN TRUSTEES. Town of. $outhold . ORIGI~AL PEIM~T NU/W~BER Southold, ~e~. York 11971 """ APPL~CAT~O~ FOR S~EC~L ICE DA~GE PE~!~ INSTRUCTIONS: Fill out form below and return to above address. You should have this application aDDroved and returned to you wi~in a Week~ 1. cant's ~-ame & Ad~ress.:. . .. . . . ' '" " 3 ........................................ o.&tgr 2. Contractor, ~ames & Address :...~ ........ ' ...........' .......... Tel. 3% The purpos~ of this application: Redrivin~ or replacing openwork dock or Openwork Pier piling, and mooring piles, removal bf damaged Piling, repair, resetting or replacement of floating' docks ramps orl 9decking'8 4-19 8 5: ~nterall necessitated, by ice and Storm damage resulting' during' SPECIAL 1. No dredging or filling is Permitted. 2. Repairs to existing structures shall be limited to replacement of timbers withodt change in design or dimension. 3.. No repair or replacement of bulkheads is Per~ittad under this permit.. 4 No freshwater or tidal wetlands are to be disturbed under any · circums tan ces. ~5. A yellow permit sign provided by this office' shall be displayed on the pro3ect at all times While ~Under rep!gcement ~ - 6. Origina! permit numbers (3'~. hivh) must be permantly displayed on project. ...................................... ,.. ..... ..... y, ~ (~ear 'off and return) ' '" ..... ~ ........... ~... ~, certify that the WOrk as authorized in this Permit has been completed and is now ready for your 'inspection. Also, the pm:mit number required' on this project PEP~MIT A~j~LBE R ':"~":' ' Si~n~d _ OWner is~._~c, learly visible. . TOWN OF. SOUTHOLD - BOARD OF TOWN TRUSTEES Pursuant to the p~o¥isions of Chapter 615 of the Laws of 1893 of the State of New Y~ork; Chapter 40i of the Laws of 1952 of ~e State ,of N~ York; the' viM,o.ns of an ordin~ce eniifled "Sout~oldT0wn Ordinate Regulat~g the of Obs~ct~ens ~ and on ~own Vgat~s and Public Lands, and the Remove.l. of G~aveI or ,~ther ~{alerials from Lm~s und~ ~own Waters , ~nd i~..acco~cewR.h the ~soluiion ,of the Bo~d ,of ~siees of the Town of South~!d adopied at a meet- ing of ia}d ~oar8 on . .~. ~..~ ....... and in co~si~er~on of the .~m ~oa-rd of T~as~ees of the To~v~ of .Southoid, Suffolk County, NeW Y~k, .:hereby bu~ea~ and d~e~e in ~ttit~c~ ~, a~l in for the issuance ~f this p.em~it does hereby release the said Board of T~astees and the ~ of $ouihold from ~y an~ all dem~es claims for d~ages or suits may ~ise ,or. occur directly or indirectly as a result of tony operation ea~ied on der and pursuan% to th~s pe~[t, mid wiI~ at his own expense, defend any ~d .all suits Which may :be. 5.fought by third parties, as a result of any operation, c~ried on pursuant to .or in accordance with the ~erms of ~is pe~it, and assume ~1 ]i.abi!ily:.with respeC~ thereto lo the complete exclusion of said Board of T~ees an~ the .~own of Souihold. T~S PERrJfT is subject to the followin~ terms and conditions: 1. Thai there ~MI be no unreasonable interference with navigation s~ a resuIt of the ~ork herein authorized. 2. T~a~ there shall 'be no interference w~ the right of the public to pass and re- pass along ~hat potion of the beach be~w~n tow and high water mark. 3. That the work M~all be subject to the supervision m~d app~ov~ of the said Board of T~stees or i'ts agent~ & ~at ~ future operations of the Tow,n of Southold require the remov~ ~d/or alteration in the location of the work herein autho~z~, or ~, in the opinion of the Board of Trustees af the Town of Sout~old, such work ~all cause reasonable .obsi~ction to f~ee navigai~on, the sa}d . .~i~. will be requi~ upon due notice from the said ~ard of T~stees, to remove or al~r the location of the ~ork hereby au~orhed without expense to ~he Tow~,of-~u~otd, so as t,o ~ender navigation reasonably free and ~obst~ct- ed. The Outhority conferred by this permit may be terminoted by the BOard of TrUstees for a failure on the part of the said ...... ~..~.....[t~.,..~..g..~...O~..~ .~.'.~.$. ..... :; ........................ to comply with the terms .and conditions herein imposed, in the event of such termination, this permit shalJ be deemed revoked five (5) days after the date when,, the Board of Trustees 'shall mail to the said ...... ;.[~...-~....~..-....~.~D.;b~ ................................ at the address given in his applicatbn,, a certified copy of a resolution of the ]~qrd of Trustees directing such termination. IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has caused its corporate seal to be hereunto affixed and these presents to 'be subscribed by a majority of the said Board of Trustees, the day and year above written. .... ~ (L S.) STATE OF NEW YORK COUNTY OF. SUFFOLK ].4~ , ~p~il , 19.6..~..., before me ON THIS .................... aay of .................................................... personally appeared Alvah B.' ~,ldsmith, Frank Dawson, ~ ~orge Simpson an~ ~u~las Rober~on, off .p~rsonally known to me, who. being by me duly sworn, severally said that they each resided in the Town of Southold, County of Suffolk, State of New York, and were members of the D~rd of Trustees of s~id Town of Southold and constituted a majori~ of the same; that they knew 'the cat.rate seal of' said Town of Southold; that the seal affixed to thc foregoing instrument was such corporate seal; that if was so affixed thereunto by o~er of the Board of Trustees of said Town of Southold and that each one signed his name thereto as a Trustee and by like order. ~ ' Noto~ Public 0 FO~ NO. I BOARD OF "tOWN TRUSTEES TOWN CLERK'S OFFICE Examiued ................................ 19 ..... Applicak!o~' 1~o...: .............. Approved [ Disapproved sic .................................................................. ii:.' ........................ ................................................... chairman, B~'~r~ of.T~rustees APPLICATION FOR PERMIT ;: !~.~ ............. · ............. A. This application :o be completely filled in by typewriter or in ink and .submitted to the: To.wu. Trustees in dup- licate. ' B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets; parks. etc., and giving detailed description of proposed layout of project must be drawn on diagram which is part of this .applica'tion. . C. The work covered By this application may nor be commenced before the issuance of'a permit. D. Upon approval of this application, Town Trustees will issue a permit to applicant. S{~ch~ permi~ shall be kept on the premises and available for inspection at all times· E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit. APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Soufhold, Suffolk County, New York, for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: dock_s, 1)jers, b__~ulkh~_~c~la, jettys and .dredKin, g in, under, and over the waters of Town of Southold. The applicant agrees to comply with all applicable laws~ ordinanfi~s, repletions and conditions specified by smd trustees, and to hold tke Town of Southold, and all To~%officials {~from ti~lkF and damages of any kind. ': ' . ' · ' ' Nam~ of Ow:e: of Prembes ITl.g.~ ~. ~.( X .%'.-k:~.:~ ~.~m.:~[. ..... -'.' ;'...'~.. .............. : .... Creek, ':ay or Harbor Fronting Property..~:~ 1.:~ ~ ~ ~.. .', ' ' S:ze of Proposed Work: LeugthO~ ~1~ ;~ ~ .... ~ :dth ~7 k... He:gkth Above H:~h Water . ~~ Depth Below Low Water .............. Average RUse In Tide ... ~ ......... Yards to Be Excavated ~ ~, Width of Canal, ~re~k 'or Bay Fronting PrepGrty ...k~. ~.~.$ .......... Depth it LOw Tide . ~.~ Is This For Private or Business UseP ....... ~.1-¢ ~ ................... Area Zoni'ng ~$~'~.P~ .a ~ Complete plot plan.to be drawn on revers~'kfde of this application. STA~TE OF NEW YORK ) ........................... eing duly sworn deposes and says that he is the applicant for the abo~e described permit, and that alt statements conlained herein are'true ro the besZ of his knowledge and belief; that the work will be done in the manner set forth in the application and as approved by the Board Southold, ~nd the applicant agrees to hold Zhe Town of Southold and sa~d rrnstees harmless and free fr~m any and all damages and claims arising under or by virtue of said~ermiR. . Sworn before this ~--' 19~ to me ................ da~ of .~ ~ ICl O ~ ~3~. - ~ot~ / / /./ / ~ff/~l~//~ ~ No. 52-1760700 NORTH